Diagnosis and treatment markers of DVT/PE (mainly on fibrin-related markers)

剛史, 松本; 英夫, 和田

doi:10.2491/jjsth.19.22

Cited by 3 publications

(4 citation statements)

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“…Subsequently, the secondary fibrinolytic reaction occurs, where the formed thrombus is degraded to d -dimer and fibrin degradation products by the action of plasmin (Figure 2). SFMC concentration, a DVT marker used in this study, reaches its peak the day after surgery and thus is useful for early postoperative DVT screening in cases where a thrombus is suspected 11–13,23 . In contrast, the concentration of d -dimer, which is a specific degradation product of solid fibrin, peaks at varying times from 7 to 14 days postoperatively, which indicates it is unsuitable for early postoperative DVT screening, although d -dimer is still useful for preoperative DVT screening because of its high NPV 9,10 (Figure 3).…”

Section: Discussionmentioning

confidence: 95%

“…SFMC concentration, a DVT marker used in this study, reaches its peak the day after surgery and thus is useful for early postoperative DVT screening in cases where a thrombus is suspected. [11][12][13]23 In contrast, the concentration of D-dimer, which is a specific degradation product of solid fibrin, peaks at varying times from 7 to 14 days postoperatively, which indicates it is unsuitable for early postoperative DVT screening, although D-dimer is still useful for preoperative DVT screening because of its high NPV 9,10 (Figure 3). We previously reported on 127 patients who underwent lumbar surgery at our department between September 2008 and September 2010.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is not useful for DVT screening during the early postoperative period, because when a DVT develops postoperatively, the d -dimer level increases from day 3 postoperatively and peaks at days 7 to 14 9,10 . In contrast, the soluble fibrin monomer complex (SFMC), an intermediate formed during the thrombogenic period, peaks the day after surgery and thus is useful for the early screening of postoperative DVT 11–13 . d -dimer is currently the most frequently used biochemical testing method but its value alone is deemed insufficient for diagnosis 14 .…”

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confidence: 99%

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Preoperative Lower Extremity Motor Weakness Affects Deep Vein Thrombosis During the Perioperative Period of Lumbar Surgery

Imuro¹,

Saito

2021

Spine

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Study Design. Prospective cohort study.Objective. The aim of this study was to assess preoperative factors in the development/exacerbation of deep vein thrombosis (DVT) in lumbar surgery and selectively perform lower-extremity venous ultrasonography (US) in patients at risk of perioperative deep vein thrombosis (DVT). Summary of Background Data. DVT is often present before lumbar surgery and also can develop or is exacerbated postoperatively. An elevated D-dimer level is predictive of DVT but not in all patients or during every operative period. The level of the thrombogenic marker soluble fibrin monomer complex (SFMC) peaks early postoperatively. Methods. The study enrolled 698 patients (396 males; 12-91 years [346 patients aged !70 years] at surgery) undergoing surgery for lumbar degenerative diseases. Patients with D-dimer levels !0.5 mg/mL or with a lower-extremity manual muscle test (MMT) < grade 3 underwent preoperative US. All preoperative DVT-positive patients and patients with SFMC levels !20 mg/mL on postoperative day 1 (POD1) underwent US. Patients with pre-and postoperative femoral-vein DVT underwent screening for pulmonary embolism (PE). Results. There were 251 patients with preoperative D-dimer levels ! 0.5 mg/mL, including 226 with MMT ! grade 3, 38 (16.8%) of whom were DVT-positive on US. In 48 patients with MMT < grade 3, DVT was detected in 16 of 25 patients with Ddimer levels ! 0.5 mg/mL (64.0%) and 10 of 23 with D-dimer levels <0.5 mg/mL (43.5%). Postoperatively, 26 of 64 preoperative DVT-positive patients (40.6%) had postoperative exacerbation of DVT; PE occurred in three. Among 100 of 634 preoperative DVT-negative patients, US revealed new DVT in 14 (2.2%) and PE in one. Preoperative DVT and new postoperative DVT were significantly more common in patients aged !70 years; postoperative DVT exacerbation was significantly more common in patients aged <70 years. A significantly higher proportion of patients with motor weakness had preoperative DVTs and postoperative exacerbated or new DVTs. Conclusion. Preoperative DVT screening by US is advisable for patients with elevated D-dimer levels, lower extremities with MMT

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Preoperative Lower Extremity Motor Weakness Affects Deep Vein Thrombosis During the Perioperative Period of Lumbar Surgery

Imuro¹,

Saito

2021

Spine

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“…The FMC levels increase earlier than the D-dimer levels at the onset of thrombosis. As the periods of increase in the FMC and D-dimer levels are approximately 1 day and 1-2 weeks, respectively, FMC can be useful for detecting thrombosis in the acute phase ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Role of Fibrin Monomer Complex in Coronavirus Disease 2019 for Venous Thromboembolism and the Prognosis

Kawame,

Kasai,

Shiohira

et al. 2023

Intern. Med.

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Objective Venous thromboembolism (VTE) is a common complication of severe coronavirus disease 2019 (COVID-19) and is associated with its prognosis. The fibrin monomer complex (FMC), a marker of thrombin generation, is reportedly useful in diagnosing acute thrombosis. To date, there has been only one report on FMC in COVID-19, and the usefulness of FMC in COVID-19 is unknown. We therefore evaluated the frequency of VTE in non-intensive-care unit COVID-19 patients in Japan and determine the clinical utility of FMC in COVID-19. Methods This was a single-center retrospective study. Laboratory test results and outcomes (thrombosis and severe progression of COVID-19) were obtained via medical record review. We assessed the relationship between FMC and VTE incidence and evaluated the association between elevated FMC levels and severe progression of COVID-19. Patients This study included 247 patients with COVID-19 who were hospitalized between December 2020 and September 2021 and had had their levels of D-dimer and FMC measured. Results Of the 247 included patients, 3 (1.2%) developed VTE. All three had elevated FMC levels on admission; however, the D-dimer level was not elevated in one case on admission. The FMC level was significantly higher in the group with severe COVID-19 progression than in the group without severe progression. A multivariate analysis showed that severe progression was associated with elevated FMC levels (odds ratio, 7.40; 95% confidence interval, 2.63-22.98; p＜0.001). Conclusion FMC can be useful for diagnosing VTE in the acute phase of COVID-19. Elevated FMC was found to be associated with severity on admission and severe progression.

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